Background: Intestinal tuberculosis is a rare form of extrapulmonary tuberculosis that can mimic other gastrointestinal disorders, such as Crohn’s disease or malignancy, often leading to diagnostic delays. Objective: Case report Material and methods: Case report Results: We report a case of a 39-year-old man who presented with severe abdominal pain, vomiting, and cessation of stool and gas passage. Physical examination revealed cachexia and diffuse abdominal tenderness, while laboratory tests demonstrated elevated inflammatory markers. Abdominal computed tomography suggested small bowel obstruction, possibly due to intestinal torsion. Emergency laparotomy was performed, revealing thickened intestinal loops and enlarged mesenteric lymph nodes. Histopathological examination confirmed granulomatous inflammation with caseation, and sputum culture was positive for Mycobacterium tuberculosis, although direct microscopy was negative. Chest radiography demonstrated pulmonary involvement. The patient was subsequently transferred to a tuberculosis reference center for initiation of anti-tuberculous therapy. Conclusions: In summary, this case underscores the need to consider intestinal tuberculosis in the differential diagnosis of intestinal obstruction, particularly in patients with chronic symptoms, malnutrition, or suggestive radiological findings. It also highlights the diagnostic limitations of sputum microscopy and the crucial role of histopathological and culture-based confirmation. Multidisciplinary management—combining surgical intervention when indicated with prompt initiation of anti-tuberculous therapy—remains essential to achieving a good clinical outcome.